Carbon dioxide (CO2) laser therapy, which is used in the clinic to treat skin conditions like hidradenitis suppurativa (HS), has generated interest among some myHSteam members. “I’m curious to see if anyone else has done CO2 laser surgery in the affected areas and seen results,” said one member. “My boyfriend has HS and has been doing this for a few months and hasn’t had as many flare-ups as he used to.”

Another myHSteam member also reported positive results: “I finished my laser treatments last week. I found them very effective, and I’m hoping the effects remain and don’t dissipate now that I’ve stopped receiving treatment.”

Doctors and dermatologists have found that CO2 laser treatments reach deep into the skin to treat symptoms and improve the quality of life of people with HS. This skin condition affects the epidermis and dermis, the skin’s top and middle layers, causing nodules (painful lumps) and sores. HS commonly affects the underarms, inner thighs, and skin around the genitals, where skin rubs together. Some people develop abscesses or pockets of pus underneath the skin, caused by an infection. Others may have sinus tracts or tunnels that develop underneath the skin, connecting nodules together.

Keep reading to learn more about what CO2 laser therapy is and how it works to treat HS symptoms deep in your skin. We’ll also cover expected side effects and what additional myHSteam members have said about their experiences with laser treatments.

1. CO2 Laser Therapy Is a Long-Standing HS Treatment

CO2 laser therapy uses lasers, or intense beams of light, mixed with carbon dioxide and other gases to create heat. The lasers are powerful enough to travel deep into the skin to both the epidermis and dermis. They’re involved in the surgical treatment of HS — surgeons use the intense light from CO2 lasers, rather than scalpels and other sharp tools, to cut through the skin.

Doctors and surgeons have been using a few types of CO2 laser therapies to treat HS since the 1980s. You might be a candidate for laser therapy if you have chronic (long-term) or severe HS that hasn’t responded to other treatments like antibiotics, steroids, or retinoids.

Another type of laser treatment, CO2 laser resurfacing, is used for wrinkles and scarring. It’s important to note that this is different from the laser therapies used for HS.

2. CO2 Laser Therapy Removes Skin Affected by Hidradenitis Suppurativa

CO2 laser therapy treats HS in a few ways, including excision therapy, vaporization, and stripping.

CO2 laser excision therapy removes entire areas of skin affected by HS. Because high-powered beams of gas and light rather than sharp surgical tools are used, you bleed less during the procedure. This helps your surgeon see exactly where the nodules and sinus tracts are to remove them.

After excision therapy, your doctor or surgeon may use marsupialization, a technique typically used to remove cysts or fluid-filled sacs that can form under the skin. During this procedure, your surgeon will drain any HS lumps or nodules. They’ll then stitch the area and create a pouch on the surface of your skin, which acts like a drain to prevent more fluid from building up.

CO2 laser vaporization and CO2 laser stripping can also be used to treat HS. These techniques take off areas of affected skin layer by layer. Like excision therapy, these treatments can remove HS lesions, sinus tracts, and nodules without damaging the healthy tissue nearby.

3. CO2 Laser Therapy Is Generally Painless and Has Few Side Effects

Your doctor or dermatologist will numb the treatment area with a local anesthetic, so you won’t feel pain during the procedure. They may also give you a sedative you take by mouth or through an intravenous (IV) catheter or thin tube inserted into a vein in your arm to help you relax. Talk to your doctor or dermatologist about what measures they use to prevent pain during CO2 laser therapy.

Once the affected skin is removed, your doctor or surgeon will close the incision with sutures or stitches, or they may leave it open to heal on its own. The average healing time after CO2 laser therapy is around one month.

Studies show that compared with other types of surgical excision to remove skin affected by HS, CO2 laser therapy produces less pain and discomfort. The most common side effects include:

• Cellulitis, a type of skin infection that causes painful inflammation and swelling
• An excess of granulation healing tissue (new tissue formed during healing), which may be a sign of infection

Be sure to follow up with your dermatologist after your treatment as recommended so that they can monitor your healing process.

4. Studies Show That CO2 Laser Excision Therapy Works as an HS Treatment

A handful of small studies have looked into how successfully CO2 laser excision therapy treats hidradenitis suppurativa. One study of 58 participants found that 95 percent saw improvement in their HS symptoms, and 91 percent would recommend CO2 laser therapy to others with HS.

The authors noted that the recurrence rate, or percentage of people who had their HS symptoms return, was 29 percent. A top risk factor was having a higher body weight, which is also a risk factor for developing HS in general.

Another study combined CO2 laser excision and marsupialization to treat 185 affected areas in 61 people with HS. Out of the 185 sites, just two had HS symptoms return. This means that this combination treatment is effective, with a very low chance of HS coming back.

5. CO2 Laser Therapy Can Be Combined With Other Laser Treatments

Along with CO2 laser therapy, your doctor or dermatologist may recommend other types of laser therapy to help treat your HS. These are known as nonablative treatments because they don’t damage your skin. Instead, they use light therapy that travels deep into your skin to target hair follicles responsible for causing your HS symptoms.

A special crystal called neodymium-doped yttrium aluminum garnet (Nd:YAG) can create heat that reaches the deep layers of skin. This type of laser destroys hair follicles that become clogged and lead to HS. Nd:YAG laser therapy has been shown to reduce inflammation and pain and prevent HS symptoms from returning. One small study in people with HS found that CO2 laser therapy plus Nd:YAG was more successful than CO2 laser therapy alone.

Some myHSTeam members have shared their experiences with laser hair removal using other types of lasers. “I’ve now had five treatments with an Nd:YAG laser on my arms and groin,” one wrote. “It’s been extremely effective. My armpits and groin are in nearly complete remission.”

Talk to Your Doctor About CO2 Laser Therapy

If you’re interested in learning more about CO2 laser therapy, talk to your doctor or dermatologist. They may recommend this treatment option if other HS treatments haven’t adequately cleared your symptoms. Your doctor or dermatologist can also cover the details, including cost and insurance coverage.

Your insurance plan may cover some or all of the costs associated with CO2 laser therapy if the treatment is considered “medically necessary.” This means you might have to try other treatment options first to prove to your insurance company that you need a second option.

Talk With Others Who Understand

On myHSteam, the social network for people with hidradenitis suppurativa and their loved ones, more than 33,000 members come together to ask questions, give advice, and share their stories with others who understand life with hidradenitis suppurativa.

Have you had CO2 laser treatment for your hidradenitis suppurativa? How effective was it? What side effects did you have? Share your experience in the comments below, or start a conversation by posting on your Activities page.